Advance Care Planning - An Innovative Palliative Care Intervention to Improve Quality of Life in Oncology
Advanced cancer typically involves multiple symptoms and seriously affects a patient’s quality of life. Anxiety and depression are common. Medical care for patients with advanced cancer should be aimed at symptom control, psychosocial support, spiritual needs, and practical issues. Patients’ preferences regarding care should be central. Open and respectful communication is of key importance, but has been found to be a challenge for health care professionals as well as patients and relatives. Advance care planning (ACP) is a formalized process of communication between patient, relatives and caregivers about the patient’s care preferences. It raises awareness of the need to anticipate future deterioration of health. ACP can improve current and future health care decision making, provide patients with a sense of control, increase adequate symptom control and improve quality of life.
The primary aim of this study is to assess whether formalized ACP improves the quality of life and symptom burden of patients with advanced cancer. Secondary aims are to assess the effects of formalized ACP on the quality of life and symptoms of patients with advanced cancer in different subgroups (gender, age, socioeconomic status, country), to assess the effects of formalized ACP on the extent to which care as received was in line with the patient’s preferences, to evaluate the patient’s experience of the decision making process, the quality of dying and the wellbeing of relatives. Further aims are to gain insight into how patients with advanced cancer, their relatives and their professional caregivers experience their involvement in ACP and to assess the cost-effectiveness of the intervention.
In a phase III multicentre cluster randomized controlled trial, pairs of at least 20 comparable hospitals (academic/non-academic) in six countries (the Netherlands, Belgium, Denmark, Italy, Slovenia, UK) will be randomized to provide patients with advanced cancer with either ACP or ‘care as usual’; 1,334 patients diagnosed with lung or stage IV colorectal cancer will be included. Patients will fill in questionnaires at inclusion, and at 2.5 and 4.5 months post-inclusion. A relative will fill in a questionnaire after the patient’s death. Use of medical care will be assessed through medical files.